Provider Demographics
NPI:1205392768
Name:DIVERSITY HEALTH SERVICES
Entity Type:Organization
Organization Name:DIVERSITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:MCKINSEY
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-302-7729
Mailing Address - Street 1:2035 WOODDALE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1517
Mailing Address - Country:US
Mailing Address - Phone:225-302-7729
Mailing Address - Fax:225-330-4758
Practice Address - Street 1:2035 WOODDALE BLVD STE E
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1517
Practice Address - Country:US
Practice Address - Phone:225-302-7729
Practice Address - Fax:225-330-4758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVERSITY HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15424Medicaid